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Pharmacare is now an all-or-nothing kind of political issue for Justin Trudeau’s Liberals, and you have to expect they will go for it all.

Universal pharmacare, the prescription-drug equivalent to medicare, is going to be a big part of this fall’s federal election campaign.

So far, it’s only a recommendation. The Advisory Council on the Implementation of National Pharmacare, chaired by former Ontario health minister Eric Hoskins, decided there’s only one way to do pharmacare: with a universal, single-payer national program where individuals pay little or nothing for a prescription.

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That’s a bit of a surprise. Finance Minister Bill Morneau had been talking about a modest pharmacare plan to fill the gaps between private and public insurance plans that leave some people uncovered.

But signs suggest the Liberals will embrace the big version, even if federal Health Minister Ginette Petitpas-Taylor wouldn’t say so outright on Wednesday. Politics give the Liberals every incentive to take it and run with it in this fall’s election campaign.

The panel headed by Dr. Hoskins, a Liberal who was health minister under former Ontario premier Kathleen Wynne, has always been part of a choreographed march toward the Liberals’ 2019 federal election platform. The council’s interim report was released March 6 and its recommendations were in Mr. Morneau’s 2019 budget two weeks later.

At any rate, Wednesday’s report means there isn’t much political value for Mr. Trudeau in the modest, fill-the-gaps approach to pharmacare. Dr. Hoskins’s advisory board rejected it outright.

The Liberals have political reasons to take the more ambitious path, too – especially now, when they have fallen behind the Conservatives in the polls.

Mr. Trudeau’s team has been desperate to build a narrative that the Liberals would put money into services that Canadians want and that Conservative Leader Andrew Scheer would embark on austerity and cost-cutting. If the Liberals run on universal pharmacare, Mr. Scheer will run against it. “It’s $15-billion,” the Conservative Leader said Wednesday. “All it means is that taxes would go up after the election.” And in promoting single-payer pharmacare, the Liberals would commandeer one of the NDP’s major social-policy planks.

That means an election where the Liberals won’t just be talking about filling the gaps of covering the roughly 20 per cent of Canadians who, according to the advisory council’s report, don’t have drug insurance or don’t have enough coverage for their needs. Dr. Hoskins argued that only a full-blown single-payer system could control spiralling drug costs.

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He proposed that Ottawa and the provinces create a list of commonly used or “essential” prescription drugs, about half of those prescribed, and insure them under a national plan starting in 2022, and then widen coverage to a comprehensive list by 2027. Most people would pay $2 per prescription for an essential drug and $5 for others, up to a maximum of $100 a year.

The additional cost would be borne by Ottawa, not the provinces, but it would be substantial: $3.5-billion for the starter plan in 2022, and $15.3-billion for the full plan in 2027.

Mr. Scheer is right: That will mean higher taxes. But there are also selling points in Dr. Hoskins’s report that the Liberals can use: The average family would save $350 a year, and the average business would save $750 per employee on drug coverage. And that last part is no small matter for small businesses that often struggle to offer drug plans.

The big question mark in the plan, however, is with Dr. Hoskins’s big claim: that a national single-payer pharmacare plan will control spiralling drug costs, partly by negotiating bulk prices, so it will be cheaper for Canadians in the end.

Some are skeptical. Sean Speer, a senior fellow with the Macdonald-Laurier Institute who served as an adviser to former prime minister Stephen Harper, argued patients might worry that a national plan will control cost by limiting the variety of covered drugs. The argument that such a plan could keep costs from spiralling “relies on the government deciding what people should get,” he said.

But politically, it fits the Liberal plan. They would be happy to force Mr. Scheer to run against a $2-per-prescription drug plan because it’s too costly. They want to make progressive voters think their proposal goes just as far as the NDP’s. After this report, it’s hard to imagine that on pharmacare, they will do something other than run with the big-ticket plan.

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NDP Leader Jagmeet Singh and Prime Minister Justin Trudeau trade partisan shots over pharmacare – an issue both parties are likely to put forward in the fall election campaign – after an expert panel called for the creation of a universal, single-payer national plan.The Canadian Press

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